PRACTICE DIARY

Chapter 33

Community relations

Dr. Brown’s solo practice is housed on the first floor of a four-plex apartment building that he owns. His patients comment that his office is homey. In fact, it has a fully equipped kitchen.

Dr. Brown’s solo practice is housed on the first floor of a four-plex apartment building that he owns. His patients comment that his office is homey. In fact, it has a fully equipped kitchen.

Jack, a 60-year-old patient, had been in excellent health except for a nagging cough, which had lasted over a month. Reluctantly, he agreed to get a chest X-ray; several days later, I had a negative chest CT report in my mailbox. Uh-oh, I thought, someone blew it. Was it the radiology department or my office?

I had clearly told Dalia, my new office manager, to order a routine chest film, but when I looked at the requisition I saw she had mistakenly ordered a chest CT. To make matters worse, my patient had major medical insurance that didn’t cover outpatient procedures and his mother, an 80-year-old retired nurse who was as sharp as a tack, knew the difference between a plain film and a CT scan. When he received a bill for $615, she called to say that was sure a lot of money for an X-ray. “Don’t worry,” I assured her, “it was our mistake and we’ll take care of it.”

What to do? Should I call the hospital administrator right off, explain what happened and ask for an adjustment in a bill that I would have to pay, or should I go through proper channels? Heck, I thought, that’s why there are managers, so I called the X-ray department’s manager. He said it was too much money for him to write off, so he kicked it up to the manager over him, who punted it to the manager under the administrator, where it sat until my patient’s mother got another bill for $615 and called me, irate. “I’ll track it down,” I promised her.

This manager implied that since the hospital had done the work, someone ought to pay for it. That someone, I told her, would be me, because it wasn’t the patient’s fault (although he might have been just a little bit curious when they stuck that IV in his arm). But it was an honest mistake and I was a good customer (whose business over the years, I implied, was not being sufficiently appreciated), so wouldn’t they consider just charging him for a chest X-ray? “I’ll have to go to the administrator to get that approved,” she said. Next time, I thought, so will I.

The memo in my box the following day said that, in the interest of improving community relations, the hospital was going to adjust the bill. “Community relations?” I complained to my wife. “What about doctor-hospital relations!”

“Same thing,” she said. “Don’t be so sensitive.”

First refusal

My medical office is in a four-plex apartment building that I own. All the other apartments had been used as residences until my downstairs tenant moved in and decided to use his space for an office too. Recently, when he told me he’d be leaving after a few months, I wondered who else I could place there. Then it occurred to me: Why not give my other tenants ample time to move and invite other health care workers to move in and practice under one roof?

As I indulged in my reverie, I realized that what I wanted was not other physicians but health care professionals who worked in what used to be known as the alternative healing arts, particularly those areas recognized by Medicare and other insurance companies. It would be a way of helping patients who couldn’t be helped by traditional allopathic therapeutics and would allow me to do something innovative in my community. I envisioned a chiropractor working with a massage therapist downstairs and an acupuncturist and psychotherapist upstairs.

What, then, should we call this amalgam of practitioners? “The Alternative Health Center” first came to mind, but “alternative” is really too ’60s and ’70s. “Complementary” medicine came into vogue in the late ’80s but seems too unrecognizable outside of academic circles. How about “The Holistic Health Center?” No, “holistic” was already cliché. Well, then, what about “The Integrative Medical Clinic?” Too New Age, I thought. It was with some satisfaction that I settled on “The Wellness Center.”

I mused how we would all work collectively and consult with each other. I considered having bi-weekly team conferences to discuss problem patients. I imagined breaking new ground and becoming a model clinic for others to emulate. Then, in the midst of my daydreams, came a wakeup call from my 90-year-old mother in Florida. “Sandy,” she said, “I want to move into that downstairs apartment when your tenant moves out. It’s time for me to live closer to the family.

“OK, Mom,” I said, realizing I had forgotten to give her the right of first refusal, and I put my fantasies away for another day.

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family practice has to offer. No real patient names have been used.